Pain Research Center, Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Korean J Pain. 2013 Jan;26(1):3-13. doi: 10.3344/kjp.2013.26.1.3. Epub 2013 Jan 4.
Chronic noncancer pain is a significant and growing public health challenge in the United States. Lacking effective alternative interventions for effective chronic noncancer pain management, many physicians have turned to opioid pharmacotherapy. Increased opioid prescribing brings not only gains in therapeutic benefit but also a higher incidence of adverse drug events including increased medication misuse and opioid related mortality. Currently the United States must confront the dual problems of widespread undertreated chronic noncancer pain and a prescription opioid abuse crisis. Withholding pain relieving drugs from patients in need is unjustifiable, yet drug diversion, abuse and adverse drug events have become major social as well as medical problems. At the heart of this crisis is the lack of definitive evidence about the risk to benefit ratio of opioid pharmacotherapy for chronic noncancer pain both on an individual case and on a population basis. This article describes the extent and severity of the American chronic noncancer pain problem and the history of opioid pharmacotherapy for chronic noncancer pain in the United States. It then discusses the concept of evidence based practice and reviews current evidence supporting opioid pharmacotherapy for chronic noncancer pain as well as adverse drug events related to opioid pharmacotherapy including misuse and abuse. Finally, it considers the conflict of providing pain relief versus protecting society and reviews steps that governmental agencies, industry and others are taking to contain and ultimately resolve the problems of excessive prescribing and conflicting priorities.
慢性非癌痛是美国一个重大且日益严重的公共卫生挑战。由于缺乏有效的替代干预措施来有效管理慢性非癌痛，许多医生转而采用阿片类药物疗法。阿片类药物处方的增加不仅带来了治疗效益的提高，还导致了更多的药物不良反应事件，包括药物滥用和阿片类药物相关死亡的发生率增加。目前，美国必须应对广泛存在的慢性非癌痛治疗不足和处方类阿片类药物滥用危机这双重问题。不给有需要的患者使用止痛药物是不合理的，但药物滥用、药物滥用和药物不良反应事件已成为重大的社会和医疗问题。这场危机的核心是缺乏关于慢性非癌痛阿片类药物治疗的个体病例和人群基础上的风险效益比的明确证据。本文描述了美国慢性非癌痛问题的程度和严重性，以及美国慢性非癌痛阿片类药物治疗的历史。然后讨论了循证实践的概念，并回顾了支持慢性非癌痛阿片类药物治疗以及与阿片类药物治疗相关的药物不良反应事件（包括滥用和误用）的现有证据。最后，它考虑了在提供疼痛缓解与保护社会之间的冲突，并审查了政府机构、行业和其他方面为遏制和最终解决过度处方和优先事项冲突问题而采取的措施。
